State Experiences with Express Lane Eligibility: Policy Considerations and Possibilities for the Future

The following document, prepared by the National Academy for State Health Policy, discusses the possible role of Express Lane Eligibility (ELE) in simplifying and streamlining enrollment into Medicaid and the Children’s Health Insurance Program (CHIP). Originally enacted as an enrollment simplification strategy for CHIP, ELE gives states the opportunity to use existing results from other means-tested human services programs to determine eligibility for Medicaid and CHIP. This helps states to not only identify individuals already known to the systems, but also reduces the documentation burden on both families and the state.

Based on the state interviews conducted for this brief, many of the states using ELE today are interested in continuing to operate the strategy to simplify enrollment and retention for children and want to expand it to be used for adults into and beyond 2014. The following brief outlines important elements of ELE and uses state-specific case studies as evidence for its effectiveness. These case studies are included as an appendix in the brief and can also be accessed separately here.

Updates

As federal health reform legislation has stalled, health policy attention turns to the states, which have many tools to reform their health care systems. While 1115 waivers rightly get a lot of attention, because of their ability to reshape state Medicaid programs, the Affordable Care Act’s Section 1332 waivers continue to be a promising avenue for states.

Where people live, work and play -- and the experiences they have, especially growing up -- matters. These social determinants of health (SDOH) include a broad array of social and environmental risk factors such as poverty, housing stability, early childhood education, access to primary care, access to healthy food, incarceration and discrimination. State policy makers are increasingly focused on SDOH because of their important influence on health care outcomes and Medicaid spending.

A major element of the federal legislative proposals to repeal and replace the Affordable Care Act is a change to the financing structure for Medicaid. Understanding the effect this funding change will have on Medicaid programs is a critical priority for states. The State Health and Value Strategies program is working to analyze the financing changes from a state perspective.